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. 2024 Oct;40(5):481-489.
doi: 10.3393/ac.2022.00311.0044. Epub 2022 Oct 11.

What can patients expect in the long term from radiofrequency thermocoagulation of hemorrhoids on bleeding, prolapse, quality of life, and recurrence: "no pain, no gain" or "no pain but a gain"?

Jean-Michel Didelot  1   2 , Benjamin Raux  3 , Romain Didelot  2 , Franz Rudler  2 , Aurelien Mulliez  4 , Anthony Buisson  3 , Armando Abergel  3 , Pierre Blanc  2
Affiliations

What can patients expect in the long term from radiofrequency thermocoagulation of hemorrhoids on bleeding, prolapse, quality of life, and recurrence: "no pain, no gain" or "no pain but a gain"?

Jean-Michel Didelot et al. Ann Coloproctol. 2024 Oct.

Abstract

Purpose: The purpose of this study was to assess the long-term efficacy of hemorrhoidal radiofrequency thermocoagulation (RFT) on bleeding, prolapse, quality of life (QoL), and recurrence.

Methods: This retrospective, single-center study, with RFT performed using procedure modified via hemorrhoid exteriorization assessed the evolution of hemorrhoidal prolapse rated by Goligher scale; bleeding and discomfort (0-10), feeling of improvement and satisfaction (-5 to +5/5) by analog scales; the impact of hemorrhoids on QoL by HEMO-FISS-QoL score.

Results: From April 2016 to January 2021, 124 patients underwent surgery and 107 were interviewed in September 2021. The average follow-up was 30 months (range, 8-62 months). The mean work stoppage was 3 days, none in 71.0% of the cases. A mean of 4,334 J was applied. No analgesics were required for 66.4% of patients. External hemorrhoidal thrombosis was the only immediate complication in 9 patients, with no long-term reported complication. Bleeding disappeared in 53 out of 102 patients or dropped from 7 to 3 out of 10 (P<0.001). Prolapse reduced from mean grade 3 to 2 (P<0.001), discomfort from 7 to 2 out of 10 (P<0.001). HEMO-FISS-QoL score improved from 22 to 7 out of 100 (P<0.001). Feeling of improvement and overall satisfaction rate were +4/5. Recurrence occurred in 21.5% of patients at 22 months, and 6 required reoperation. Of the patients, 91.6% would choose the same procedure again and 96.3% recommend it.

Conclusion: RFT, although imperfect, leads to a significant improvement in hemorrhoidal symptoms and a lasting increase in QoL with minimal pain and downtime, high acceptance, and low complication and recurrence rates.

Keywords: Hemorrhoids; Minimally invasive surgical procedure; Quality of life; Radiofrequency ablation; Rafaelo procedure.

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Conflict of interest statement

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Intervention using hemorrhoidal radiofrequency thermocoagulation with the HPR45i probe (F-Care-Systems) with externalization of internal hemorrhoids.
Fig. 2.
Fig. 2.
Comparative evolution of intensity of the bleeding and of hemorrhoidal prolapse (P-value calculated for differences between preoperative and postoperative evolution).
Fig. 3.
Fig. 3.
Chronologically sequenced recurrence curves following 4 periods of intervention (from April 2016 to December 2020).
See this image and copyright information in PMC

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